Thoracolaparoscopic versus open approach for thoracic esophageal squamous cell carcinoma: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZOU Zhiqiang , YUAN Lei , HU Fengbiao , SUI Gang , LIU Yu

Department of Thoracic Surgery, Jinan Military General Hospital, Jinan, 250031, P.R.China;

Corresponding author：

ZOU Zhiqiang, Email: zdyddy2000@tom.com

Keywords：

Thoracic esophageal squamous cell carcinoma; minimally invasive esophagectomy; lymph node dissection

DOI：

10.7507/1007-4848.201612001

Video：

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Objective To evaluate the security and outcomes of thoracolaparoscopic esophagectomy (TLE) versus open approach (OA) for thoracic esophageal squamous cell carcinoma. Methods From June 2014 to June 2015, 125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through McKeown approach, including TLE (a TLE group, 107 patients, 77 males and 30 females) and OA (an OA group, 18 patients, 13 males and 5 females). The data of operation and postoperative complications of the two groups were analyzed retrospectively. Results There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group (333.58±72.84 min vs. 369.17±91.24 min, P=0.067; 2.84±1.44 d vs. 6.44±13.46 d, P=0.272; 4.71±3.87 vs. 3.89±3.97, P=0.408) . There was a statistical difference in blood loss, total resected lymph nodes and resected lymph nodes groups between TLE group and OA group (222.62±139.77 ml vs. 427.78±276.65, P=0.006; 19.62±9.61 vs. 14.61±8.07, P=0.038; 3.70±0.99 vs. 3.11±1.13, P=0.024). The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group (P=0.608). There was a statistical difference (P=0.011) in incidence of pulmonary infection (2.8% in the TLE group and 16.7% in the OA group). Incidences of complications, such as anastomotic leakage, cardiac complications, left-side hydrothorax, right-side pneumothorax, voice hoarse and incision infection, showed no statistical difference between two groups. Conclusion For patients with thoracic esophageal squamous cell carcinoma, TLE possesses advantages of more harvested lymph nodes, less blood loss and less pulmonary infection comparing with open approach, and is complied with the principles of security and oncological radicality of surgery.

Citation： ZOU Zhiqiang, YUAN Lei, HU Fengbiao, SUI Gang, LIU Yu. Thoracolaparoscopic versus open approach for thoracic esophageal squamous cell carcinoma: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 78-82. doi: 10.7507/1007-4848.201612001 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	王文凭, 陈龙奇. 食管癌外科治疗的现状与展望. 中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
3.	常栋, 王天佑. 我国食管癌外科手术入路现状与进展. 中华临床医师杂志 (电子版), 2012, 6(20): 131-133.
4.	Shimi SM, Nathanson LK, Cuschieri A. Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach. Br J Surg, 1992, 79(6): 533-536.
5.	DePaula AL, Hashiba K, Ferreira EA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc, 1995, 5(1): 1-5.
6.	Watson DI, Davies N, Jamieson GG. Totally endoscopic Ivor Lewis esophagectomy. Surg Endosc, 1999, 13(3): 293-297.
7.	Weijs TJ, Ruurda JP, Nieuwenhuijzen GA, et al. Strategies to reduce pulmonary complications after esophagectomy. World J Gastroenterol, 2013, 19(39): 6509-6514.
8.	Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg, 2010, 199(5): 594-598.
9.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
10.	Kubo N, Ohira M, Yamashita Y, et al. The impact of combined thoracoscopic and laparoscopic surgery on pulmonary complications after radical esophagectomy in patients with resectable esophageal cancer. Anticancer Res, 2014, 34(5): 2399-2404.
11.	Nagpal K, Ahmed K, Vats A, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc, 2010, 24(7): 1621-1629.
12.	刘勇恩, 寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 2008, 15(2): 138-142.
13.	Avendano CE, Flume PA, Silvestri GA, et al. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73(3): 922-926.
14.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
15.	Hsu PK, Huang CS, Wu YC, et al. Open versus thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma. World J Surg, 2014, 38(2): 402-409.
16.	谭黎杰, 王群, 冯明祥, 等. 电视胸腔镜食管切除术在食管癌外科治疗中的应用. 中华胃肠外科杂志, 2008, 11(1): 24-27.
17.	Cho JW, Choi SC, Jang JY, et al. Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View. Clin Endosc, 2014, 47(6): 523-529.
18.	Guo X, Mao T, Gu Z, et al. Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma. Thorac Cancer, 2015, 6(2): 146-150.
19.	Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212(4): 560-566.
20.	吴灿兴, 张树亮, 陈椿. 胸段食管鳞癌患者的喉返神经旁淋巴结转移特点. 中华胸部外科电子杂志, 2016, 3(1): 21-24.
21.	Zhang R, Liu S, Sun H, et al. The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy. Interact Cardiovasc Thorac Surg, 2014, 19(2): 308-310.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. 王文凭, 陈龙奇. 食管癌外科治疗的现状与展望. 中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
3. 常栋, 王天佑. 我国食管癌外科手术入路现状与进展. 中华临床医师杂志 (电子版), 2012, 6(20): 131-133.
4. Shimi SM, Nathanson LK, Cuschieri A. Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach. Br J Surg, 1992, 79(6): 533-536.
5. DePaula AL, Hashiba K, Ferreira EA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc, 1995, 5(1): 1-5.
6. Watson DI, Davies N, Jamieson GG. Totally endoscopic Ivor Lewis esophagectomy. Surg Endosc, 1999, 13(3): 293-297.
7. Weijs TJ, Ruurda JP, Nieuwenhuijzen GA, et al. Strategies to reduce pulmonary complications after esophagectomy. World J Gastroenterol, 2013, 19(39): 6509-6514.
8. Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg, 2010, 199(5): 594-598.
9. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
10. Kubo N, Ohira M, Yamashita Y, et al. The impact of combined thoracoscopic and laparoscopic surgery on pulmonary complications after radical esophagectomy in patients with resectable esophageal cancer. Anticancer Res, 2014, 34(5): 2399-2404.
11. Nagpal K, Ahmed K, Vats A, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc, 2010, 24(7): 1621-1629.
12. 刘勇恩, 寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 2008, 15(2): 138-142.
13. Avendano CE, Flume PA, Silvestri GA, et al. Pulmonary complications after esophagectomy. Ann Thorac Surg, 2002, 73(3): 922-926.
14. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
15. Hsu PK, Huang CS, Wu YC, et al. Open versus thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma. World J Surg, 2014, 38(2): 402-409.
16. 谭黎杰, 王群, 冯明祥, 等. 电视胸腔镜食管切除术在食管癌外科治疗中的应用. 中华胃肠外科杂志, 2008, 11(1): 24-27.
17. Cho JW, Choi SC, Jang JY, et al. Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View. Clin Endosc, 2014, 47(6): 523-529.
18. Guo X, Mao T, Gu Z, et al. Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma. Thorac Cancer, 2015, 6(2): 146-150.
19. Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212(4): 560-566.
20. 吴灿兴, 张树亮, 陈椿. 胸段食管鳞癌患者的喉返神经旁淋巴结转移特点. 中华胸部外科电子杂志, 2016, 3(1): 21-24.
21. Zhang R, Liu S, Sun H, et al. The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy. Interact Cardiovasc Thorac Surg, 2014, 19(2): 308-310.

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Thoracolaparoscopic versus open approach for thoracic esophageal squamous cell carcinoma: A case control study

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